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Background of Proposed Project:
Concussion, also known as mild traumatic brain injury (mTBI) refers to a complex pathophysiological process following a head trauma. While most adult concussions see symptoms resolving completely within 2 weeks, there are a number of individuals who experience prolonged symptoms or post-concussion syndrome, ranging from headache disorders and mental health issues to cognitive difficulties and vestibular problems . Between 2020-2021 in Australia there were 17700 emergency department (ED) presentations and 10800 hospitalisations for concussion. This data set also summarised that First Nations people and people living in rural and remote Australia were more likely to be hospitalised with head injury . Occupational Therapists (OTs) offer a unique, holistic perspective of individuals and are well versed in the necessary skills to identity, assess, and treat the functional impact that concussion can impose. Among other forms of assessment, The OT team at Alice Springs Hospital (ASH) frequently use the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) to objectively understand the presence and severity of concussive symptoms that may impact a person’s ability to engage in activities of daily living (ADLs). With ASH servicing around an 85% Indigenous patient population and the often myriad of neurocognitive nuances experienced by our presenting population, the OT team are eager to pursue projects that are culturally considered and relevant to the unique needs of our community. As such, the OT team have embarked on a project to adapt the RPQ to; 1) help us, other health professionals and our patients better understand the concussion symptoms being experienced and its effects on daily function, 2) continue to employ an objective measuring tool that can be used in the acute, rehabilitation and outpatient/community setting and 3) ensure we are providing appropriate and culturally considered education and interventions that is of the highest quality, across the spectrum of our service. Our poster aims to invite viewers to our developments in this project with the aim of raising awareness of our practise in this domain and its’ nuances in Central Australia.
Relevance to OT knowledge and practice and Rural and Remote Health:
Historically, theories into the management of concussion have emphasised a complete rest approach, however emerging research is clearly recommending graded transition into daily function shortly following injury, within the limits of exacerbating symptoms. With concussion being complex in nature and affecting engagement in daily activities on multiple levels, OTs are well equipped to work alongside their patients in symptom recognition and education, providing adaptations to maximise participation, and in gradually supporting patients to re-engage in occupations safely.
The ANZ Concussion Guidelines suggest that referral to interdisciplinary teams/clinics or subspecialists should be considered for people experiencing concussion symptoms lasting more than four weeks. In rural and remote areas where access to such services may be difficult, general practitioner monitoring alongside specialist telehealth services is advised to coordinate a follow up plan .
Project considerations:
The OT team acknowledges the importance of consultation with ASH’s Aboriginal Liaison Officers in this pursuit. It is also acknowledged that currently and to our knowledge, no formal concussion specific follow up services are available in Alice Springs outside of a limited outpatient rehabilitation service, and therefore this project may also act as a catalyst for further exploration of the service gaps in our remote setting.
Future CQI:
Alongside this adapted tool, the OT team anticipates future CQI in developing culturally appropriate education/advice for concussion/mTBI, exploring the OT role within the emergency department, and in advocating for the importance of adequate follow up services including possible concussion clinics or upskilling remote health clinics in managing prolonged concussion symptoms. |
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